Nutritional care and support for patients with tuberculosis

WHO/Marko Kokic

Undernutrition is an important risk factor for TB and TB causes undernutrition. This bi-directional association leads to a high prevalence of undernutrition among people with TB. Proper TB treatment helps restore normal weight and nutrition. However, the time to full nutritional recovery can be long and many TB patients are still undernourished after TB treatment is completed. Therefore, it is important to do a nutritional assessment at the time of TB diagnosis and provide nutritional care accordingly. To this end, WHO has issued guideline on nutritional care and support for people with TB.

There is no good evidence that nutritional care improves TB-specific treatment outcomes, once proper treatment with TB medicines is provided. However, there is strong evidence that proper nutritional care improves nutritional recovery for people who are undernourished, and therefore helps reduce general health risks. This applies also to people with TB.

Food-insecurity can be an important barrier for accessing and adhering to TB treatment. Catastrophic costs of TB illness and TB care can increase food-insecurity. There is often a vicious circle of underlying vulnerability leading to TB, and TB leading to aggravated vulnerability. The evidence on food support as an enabler for accessing and adhering to TB treatment is inconclusive. However, experiences suggest that food support can be a critical component of enablers and social protection packages, especially in food-insecure populations. Food support as an enabler is not part of the present guideline on nutritional care and support for people with TB. Instead, WHO is in the process of assessing the evidence and develop policy on social support and social protection for people with TB and TB affected households, including food support.